Document Detail


Surgical treatment of unstable type II odontoid fractures in skeletally mature individuals.
MedLine Citation:
PMID:  20881464     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Systematic review of literature.
OBJECTIVE: To determine the optimal indications and methods of surgical treatment for unstable type II odontoid fractures in skeletally mature individuals.
SUMMARY OF BACKGROUND DATA: Odontoid fractures are a frequently encountered injury pattern in the cervical spine. The surgical treatment of type II odontoid fractures varies among spinal surgeons. The optimal surgical indications and treatment for type II odontoid fractures remains unclear.
METHODS: Five primary research questions, based on safety and efficacy, were determined by consensus of a panel of spine trauma surgeons consisting of fellowship trained orthopedic and neurologic surgeons. A comprehensive review of the literature was performed using MeSH search terms in MEDLINE, PubMed, EMBASE, CINAHL, and the Cochrane Database of Systematic reviews. The quality of literature was rated as high, moderate, low, or very low. Using the GRADE evidence-based review system, the primary questions were answered using the literature review and expert opinion. These treatment recommendations were then rated as either strong or weak based on the quality of evidence and clinical expertise.
RESULTS: The initial search resulted in over 1300 results. After initial application of all inclusion and exclusion criteria, 458 abstracts were reviewed from which 22 manuscripts were found to meet all criteria. These were obtained, reviewed, and used to create an evidentiary table. All articles were of either low or very low quality.
CONCLUSION: There is no moderate or high quality literature on the surgical management of acute type II odontoid fractures. Optimal indications for either anterior or posterior treatment of fractures are described but with no comparative data. A single anterior odontoid screw is the recommended technique for anterior treatment. Posterior internal fixation (C1-C2 transarticular screw, C1-C2 segmental fixation) is the recommended technique for posterior treatment. In equivocally indicated instances, anterior or posterior treatment can be safely used with good outcome. In this scenario, surgical management decision should be influenced by surgeon and patient preference as well as cost considerations.
Authors:
Alpesh A Patel; Ron Lindsey; Jason T Bessey; Jens Chapman; Raja Rampersaud;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Spine     Volume:  35     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2011-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S209-18     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery and Neurosurgery, University of Utah, Salt Lake City, UT 84108, USA. alpesh.patel@hsc.utah.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bone Screws
Evidence-Based Medicine
Fracture Fixation* / adverse effects,  instrumentation
Fracture Healing
Humans
Internal Fixators
Joint Instability / radiography,  surgery*
Middle Aged
Odontoid Process / injuries,  radiography,  surgery*
Patient Selection
Spinal Fractures / radiography,  surgery*
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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